Analysis of kinematic, kinetic and electromyographic patterns during root canal preparation with rotary and manual instruments

Objective: This study assessed the muscular activity during root canal preparation through kinematics, kinetics, and electromyography (EMG). Material and Methods: The operators prepared one canal with RaCe rotary instruments and another with Flexofiles. The kinematics of the major joints was reconstructed using an optoelectronic system and electromyographic responses of the flexor carpi radial's, extensor carpi radialis, brachioradialis, biceps brachii, triceps brachii, middle deltoid, and upper trapezius were recorded. The joint torques of the shoulder, elbow and wrist were calculated using inverse dynamics. In the kinematic analysis, angular movements of the wrist and elbow were classified as low risk factors for work-related musculoskeletal disorders. With respect to the shoulder, the classification was medium-risk. Results: There was no significant difference revealed by the kinetic reports. The EMG results showed that for the middle deltoid and upper trapezius the rotary instrumentation elicited higher values. The flexor carpi radialis and extensor carpi radialis, as well as the brachioradialis showed a higher value with the manual method. Conclusion: The muscular recruitment for accomplishment of articular movements for root canal preparation with either the rotary or manual techniques is distinct. Nevertheless, the rotary instrument presented less difficulty in the generation of the joint torque in each articulation, thus, presenting a greater uniformity of joint torques.

Erros de utilização de assentos de segurança infantil por menores de 4 anos

OBJETIVO: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. MÉTODOS: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. RESULTADOS: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). CONCLUSÃO: Os dados são coerentes com publicações internacionais.

Distúrbios osteomusculares relacionados ao trabalho em profissionais de enfermagem: revisão integrativa da literatura

OBJETIVO: Avaliar as evidências sobre o adoecimento de trabalhadores de enfermagem pelos Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). MÉTODOS: Revisão integrativa da literatura utilizando as bases: Biblioteca Virtual em Saúde (BVS), BVS Enfermagem, Scopus e Banco de Teses da Universidade de São Paulo (USP) obtendo-se 17 estudos. RESULTADOS: Evidenciou-se que os DORT acometem os profissionais de enfermagem e relacionam-se às condições inadequadas dos ambientes de trabalho, à organização e estrutura do trabalho. CONCLUSÃO: É necessário investir em programas preventivos, capacitações, educação em saúde, estratégias de intervenção e organização dos serviços existentes.

Qualidade de vida no trabalho e distúrbios osteomusculares relacionados ao trabalho entre profissionais de enfermagem

OBJETIVO: Avaliar a associação de Qualidade de Vida no Trabalho (QVT) com os distúrbios osteomusculares (DORT) entre profissionais de enfermagem que trabalham em bloco cirúrgico. MÉTODOS: Estudo de abordagem quantitativa, descritivo, transversal e correlacional, do qual participaram 211 trabalhadores de Enfermagem de 11 hospitais de Londrina-PR, Brasil. Para coleta de dados, foram utilizados três instrumentos: caracterização sociodemográfica e profissional, Escala Visual Analógica e o Questionário Nórdico. RESULTADOS: A maioria dos participantes era de auxiliares de enfermagem (62,6%), do sexo feminino (87,1%), casados (54,5%), com idade média de 40 anos. Dentre os participantes, 38,9% apresentavam queixas osteomusculares na região inferior das costas e 37,9%, na região dos ombros. Neste estudo, a QVT obteve associação estatisticamente significante com os distúrbios osteomusculares na região lombar e dos ombros nos últimos 12 meses (p=0,00). CONCLUSÃO: A ausência de lombalgia contribuiu significativamente para elevar a medida de QVT (p=0,010), embora o modelo final de regressão tenha explicado, apenas 22,6% da variância da medida de QVT.

Estudo epidemiológico de queimaduras em crianças atendidas em hospital terciário na cidade de São Paulo

INTRODUÇÃO: O objetivo deste estudo é descrever a experiência da Unidade de Tratamento de Queimados da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), em 15 meses consecutivos, no atendimento às crianças queimadas. MÉTODO: Foram analisados os dados de 98 pacientes, com idade < 13 anos, atendidos na Unidade de Tratamento de Queimados do HCFMUSP, de outubro de 2009 a dezembro de 2010. RESULTADOS: A média de idade das crianças atendidas foi de 5,2 anos, sendo 67 (68,4%) do sexo masculino. Os acidentes foram responsáveis por 93 (94,9%) casos, enquanto em 1 (1%) caso ocorreu agressão. Observou-se maior ocorrência de queimaduras em crianças com até 2 anos de idade. O principal agente da queimadura foi escaldadura (48%), seguido de fogo (17%) e sólido aquecido (17%). A média da superfície corpórea queimada de 2º e 3º graus foi de 10%. Seis (6,1%) pacientes apresentaram > 20% da superfície corpórea queimada, 5 (83,3%) deles por combustão de álcool e 1 (16,7%) por escaldo com água. Entre os 3 casos em que a superfície corpórea queimada de 2º e 3º graus foi > 30%, todos ocorreram por combustão de álcool. CONCLUSÕES: O levantamento demonstra a importância da queimadura em pacientes da faixa etária pediátrica. O conjunto de dados obtidos permite inferir que os esforços de prevenção devem se concentrar no ambiente doméstico, contra a possibilidade de ocorrência de escaldaduras nas crianças com < 5 anos de idade. A partir dos 5 anos, as campanhas devem abordar tanto o ambiente doméstico como o extradoméstico.

Need for recovery from work and sleep-related complaints among nursing professionals

The concept of need for recovery from work (NFR) was deduced from the effort recuperation model. In this model work produces costs in terms of effort during the working day. When there is enough time and possibilities to recuperate, a worker will arrive at the next working day with no residual symptoms of previous effort. NFR evaluates work characteristics such as psychosocial demands, professional work hours or schedules. However, sleep may be an important part of the recovery process. The aim of the study was to test the association between sleep-related complaints and NFR. A cross-sectional study was carried out at three hospitals. All females nursing professionals engaged in assistance to patients were invited to participate (N=1,307). Participants answered a questionnaire that included four sleep-related complaints (insomnia, unsatisfactory sleep, sleepiness during work hours and insufficient sleep), work characteristics and NRF scale. Binomial logistic regression analysis showed that all sleep-related complaints are associated with a high need for recovery from work. Those who reported insufficient sleep showed a greater chance of high need for recovery; OR=2.730 (CI 95% 2.074-3.593). These results corroborate the hypothesis that sleep is an important aspect of the recovery process and, therefore, should be thoroughly investigated.

Air accident investigation among regulatory agencies

The aim of this manuscript is to describe and compare regulatory aviation agencies according to their subordination and attributions to investigate air accidents. Possible consequences in identifying the contributory factors are also presented. Distinct procedures investigating air accidents among agencies lead to a lack of standardization of the statistics, making it difficult to analyze the data globally. Separately the information does not configure the entire scenario of what occurred, affecting the analysis and subsequent interventions. We recommend a joint and collaborative work between the different committees that operate in the investigation of air accidents.

Harassment at work? Empowerment and autonomy as coping strategies of young workers

There is a considerable number of researches about workplace violence, but few relate young workers and work harassment. This study aimed to investigate the reported perceptions of young apprentices and trainees about moral harassment at work and related coping strategies. Forty adolescent workers (22 men and 18 women) between 15 and 20 years old who received training by a non-governmental organization in Sao Paulo, Brazil, participated in the study. Data collection included individual and collective interviews. It was used an in-depth semi structured interview protocol. The discourses were analyzed using the hermeneutic-dialectic frame. Results showed that young workers reported little or no knowledge of strategies to cope with moral harassment at work, showing vulnerability to the effects of aggression. Effective coping strategies at work should embrace two important concepts of health promotion: empowerment and autonomy.

Morbidity among nursing personnel and its association with working conditions and work organization

Introduction: Work organization patterns and working conditions experienced by nursing personnel in the hospital settings may be associated to increased morbidity among these health workers. Aim: To estimate the prevalence and factors associated with self-reported diseases among nursing personnel at the emergency hospital in Rio Branco/ State of Acre, Brazil. Methods: A cross-sectional study was conducted involving 272 participants who answered a questionnaire including sociodemographic characteristics, working conditions, lifestyles, work ability, and a fatigue perception scale. The self-reported diseases in the 12 months prior to data collection were considered the dependent variable. Results: A total of 85.7% of the participants reported one or more diseases in the past 12 months. Most prevalent diseases were: musculoskeletal diseases (37.1%), digestive diseases (28.7%), mental disorders (28.3%), work injuries (27.9%), and respiratory diseases (26.8%). The following significant variables remained in the final model: high work demands (OR 2.69), reported fatigue (OR 3.59), night work (OR 6.55) and being a technician or nursing assistant (OR 4.23). Conclusions: Variables related to working conditions and work organization were associated with the occurrence of reported diseases among nursing professionals. Health promotion measures at work require a comprehensive approach including the working conditions and the work organization.

Work and technological innovation in organic agriculture

Organic agriculture is a sustainable cultivation ecologically, economically and socially. Several researches in organic agriculture have been made from technical perspectives, economic traits or related to ecological aspects. There are practically no investigations into the nature of the technology used in organic agriculture, especially from an ergonomic perspective. From the activity analysis, this study aimed to map the technology used in the production of organic vegetables. Properties producing organic vegetables were selected representing the State of Sao Paulo. It was applied an instrument (questionnaire and semi-structured interview) with their managers and it was made visual records to identify adaptations, innovations and technological demands that simultaneously minimize the workload and the difficulties in performing the tasks and increase work productivity. For some of the technological innovations a digital scanner was used to generate a virtual solid model to facilitate its redesign and virtual prototyping. The main results show that organic farmers have little technology in product form. The main innovations that enable competitive advantage or allow higher labor productivity occur in the form of processes, organization and marketing.

Work ability among hospital food service professionals: multiple associated variables require comprehensive intervention

The work of hospital food service is characterized by demands that can be associated with work ability - WA. The aim of this study was to evaluate factors associated with WA among hospital food service professionals and recommend intervention measures. This is a cross sectional study carried out in 2009, conducted in a hospital of Sao Paulo, Brazil. Participants were 76 (96.2%) of the eligible. They filled out a questionnaire including socio-demographic data, life styles, working conditions and WA. Multivariate linear regression analyses were performed. Factors associated with WA were age (p=0.051), over commitment (p=0.011), effort-reward ratio (p=0.002) and work injuries (p<0.001). In spite was a young population, age was associated with WA. Association with work injuries is consistent with the theoretical model that demonstrated that health status is the basis to maintain the WA. The association of effort-reward imbalance shows that issues related with work organization are relevant for these workers. The association of overcommittment suggests that workers recognize their responsibility with the therapeutic processes of patients. Results showed a number of features of different nature that should be taken into account when implementing measures to improve the WA, to be applied at different levels: individual, task and institutional.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917